Irregular corneas
Keratoconus, pellucid marginal degeneration, scarring and corneal transplants produce a surface no soft lens can correct. A rigid optical surface is needed: a rigid gas permeable lens on the cornea for milder cases, a hybrid for comfort, and a scleral lens for moderate to advanced irregularity, which vaults the whole cornea and gives the most stable vision and comfort.
High astigmatism and unusual prescriptions
Stock toric soft lenses cover limited astigmatism and rotate on some eyes. Custom soft toric lenses are made in any cylinder and axis with stabilization tuned to the eye. Rigid and hybrid lenses correct astigmatism by their shape rather than by rotation, and suit patients whose torics never settle. Very high prescriptions in either direction are made to order in soft, rigid or scleral designs.
Presbyopia with astigmatism
Patients over 45 who need both astigmatism and reading correction have fewer stock options. Custom soft multifocal torics, multifocal rigid lenses and multifocal scleral lenses all combine the two, and monovision fittings remain an option. Refractive Lens Exchange is discussed for patients who would rather leave lenses behind.
Corneas altered by surgery
LASIK, PRK and RK flatten the central cornea, and standard lenses vault the flat center and touch the periphery, causing decentration and discomfort. Reverse-geometry rigid lenses, whose periphery is steeper than their center, and scleral lenses, which ignore the corneal shape, fit these eyes well. Corneal transplants, with a steep, tilted or irregular graft, are almost always fitted with scleral lenses.
Dry eye and sensitive eyes
Dry eye is the most common reason lenses fail in otherwise ordinary eyes. Treating the dryness is the first step. Daily disposable soft lenses in a low-dehydration material help mild cases; scleral lenses, whose fluid reservoir bathes the cornea, are the answer for moderate and severe dryness. Patients with lens-related allergy or giant papillary conjunctivitis move to daily disposables or rigid lenses, with treatment of the lids.
Is this right for your eyes?
Nothing on this page is a diagnosis. Whether this is the right choice for you is decided by a full examination at one of our 4 offices: Pasadena, Huntington Beach, Woodland Hills and Beverly Hills.
About this content: This page was written with the assistance of AI tools and reviewed for medical accuracy by Dr. Arbi Melikian, OD. It is general information, not medical advice, and does not replace an eye examination. Individual results vary. Read our medical disclaimer.
